How to Choose Your Orthodontist

Let’s be blunt:

Questions to ask the orthodontist?

Are you a diplomate of the American Board of Orthodontics? A board certified orthodontist is an orthodontist who has voluntarily gone through the process of demonstrating their judgement, skills, and knowledge to their peers in an effort to ultimately provide the highest level of patient care. This requires extensive testing and presenting treated cases in a very complex and detailed manner. It demonstrates that they are passionate about their profession and are trying to excel in the field of orthodontics.

Do they show you their finished work? If not, they may not have results worth showing. Trust me, we all have egos. If you are an artist, you love to show your work.

Who puts the braces on? It should be the orthodontist.

Do you put braces on the second molars? A lot of orthodontists do not align the second molars. It is critical to the “bite” or occlusion that they be aligned.

Do you treat to centric relations, CR? This is when you treat to condylar position. You get the teeth to fit when the condyles are seated in the fossa of the joint. There are no premature contacts, no open areas and only one bite where all the teeth hit except for the front four incisors which are slightly out of contact.

Do you treat to canine rise? This is where only the canines contact then moving the lower jaw from side to side.

Do you put in straight wire only or do you make detail bends? If you do use detail bends in the archwire, who puts the bends in, the assistants or the orthodontist? You want an orthodontist who can bend wire for detailed tooth movement. Many orthodontists just have their assistants place straight wire in.

Do you use bite-plates to help correct the overbite or do you intrude the maxillary incisors first or during treatment? You want to have an orthodontist that can control the height of the maxillary incisors so that you show all or most of the maxillary incisors when you smile. If you intrude the maxillary incisors and show the lower incisors too much, it is very aging and it looks odd.

Do you upright the lower canines and use a broad arch form? Upright lower canines are necessary to fit with a broad arch. Otherwise the teeth will be tipped in. This doesn’t look good and it isn’t as stable. They can continue to tip in. If the canines are tipped out, they are more likely to stay tipped out.

Do you align the maxillary incisors to follow the curve of the lower lip? A straight line on the upper front teeth looks unnatural. When there is a curve like the lower lip, it looks attractive and “showy”.

Do you use cervical headgear as opposed to high-pull headgear? Cervical or neck headgear pulls down and back on the upper first molars which can rotate the mandible down and back making the chin further receded.

Do you extract one lower incisor as a treatment option in crowded cases? This is not a good choice and means that the orthodontist is not particular about the bite or fit the teeth.

When the braces are removed, do you place a fixed lower anterior retainer that is made of heavy wire and pads? A flexible wire isn’t going to hold the position but the heavy wire and pad system requires that you are a good “wire bender”. It takes more skill but is the best retainer. If only a removable retainer is used it probably means they do not know how to adapt the fixed retainer.

What kind of upper retainer do you use? The best retainer is a full coverage thin plastic retainer. It has to be made to the best fit of the teeth which means that it may take a few hours of lab time to mark how the teeth fit and adjust the models slightly so that the retainer is made to the absolute best fit. By doing this, the teeth are being allowed to move to this absolute best position. Otherwise, they could move to this best fit position during the day and then move back when the retainer is worn. Most orthodontist just make the retainer to the impression that was taken at the deband appointment and do not spend the time to check and detail the models.

Do you have an in-house lab and how long does is it between the deband appointment and the seating of the retainers? If you do not have an in-house lab, it could take a week before getting your retainers. I like to seat the retainers the same day so that the teeth do not move. We can do this only because we have an in-house lab.

Do you use a .018 slot in the braces or a .022 slot? A .022 gives control and you can position the teeth where you want but an .018 is used when the orthodontist doesn’t know how to bend wire or how to control the bigger wire. Do not go to an orthodontist that uses a .018 system.

Do you use braces with “doors” rather than open slots? The “door” systems are sloppy systems that are designed to have the assistants do the work—not a good sign or system. You see root resorption, tipped out teeth, bone loss, and poor bites with these systems. Giving up this control would not be an option for a orthodontist who can control tooth movement, bend wire, control growth, etc. It would be a great option for an orthodontist who can’t do these things.

Do you treat steep lower jaw cases the same as flat lower jaw cases? If the orthodontist treats them the same and you have a steep lower jaw, you may end up being a surgical case and the orthodontist will just blame it on your “joint” problem.

If there is severe wear on the teeth, how do you handle it? Do they build up severely worn teeth so that they will know how the final result will look or do they just “wing” it. (Minor wear can be handled after treatment)

Do you do treatment simulations for orthodontic treatment and for your surgical treatments? If not, they do not want to buy the software or they just do not know how to do it.

How do you handle the “black triangle” problem seen in adult cases? If they do not have a technique to handle this, they are not a “detailer”.